San Francisco Peaks Research Paper Example | Topics and Well Written Essays - 1000 words

San Francisco Peaks - Research Paper Example However this entire mystery was resolved in 1980 when Mount St. Helen’s erupted. It is because of this erosion that the scientists and geologists were able to figure out that due to volcanoes a mountains entire face can disappear. Further, with the help of the geological testing and aerial photos it was concluded that the San Francisco Peaks experience the same kind of erosion and that is why it took a unique formation. It is believed by the geologists that the actual peaks were more than 16,000 feet high (San Francisco Peaks) The Peaks The San Francisco Peaks are located to the north of Flagstaff, Arizona and has a height of about 12,633 feet. It is considered to be the most distinct geological mark of the Colorado Plateau. These peaks have been named after the settler in the region the early 1620s named St. Francis of Assisi, however in the local area these are referred to as Peaks. The peaks are a collective formation of six summits that encircle the volcanic crater, which is now a quiet volcano. Out of all the six, the highest peak in Arizona is Humphreys Peak that is 12,633 feet high, Agassiz Peak is about 12,356 feet and the Fremont Peak soars up to 11,969 feet. The remaining three peaks; Aubineau Peak, Reese Peak and the Doyle Peak climb up to 11,838 feet, 11,474 feet and 11,460 feet respectively. Together all these peaks make a circular ring making the peaks the most significant geological display of volcanic rocks, together with the picturesque view of the lava flows and the deep alpine forest. As the peaks are a unique formation, they provide a dramatic landscape of the Flagstaff that is isolated, huge and quite unexpected. Since the peaks are quite tower-like, these can be viewed from quite a distance even from the Wupatki National Monuments (Priest, Duffield and Malis-Clark). Today these peaks have become tourist attractions as millions of people visit this place every year. The Peaks have a protected alpine environment (Inner Basin), a ski r esort (Arizona Snowbowl) and the Humphreys Peak (the highest point of Arizona). People visit the place for hiking, wildlife viewing, camping, and skiing and wilderness seclusion. The Formation of the Peaks Arizona’s volcanic pleasures begin to form about 6 million years ago when there were 600 volcanic eruptions in the region. It was due to these volcanic eruptions that the Peaks were formed, mainly the Humphrey’s peak that soared above the terrain making it a geological landscape, otherwise it would just have been a dry and arid plateau. Although the history of the formation of the Peaks varies in the region however the general geologic history remains quite the same. Nearly about 500 million years ago the Plateau region was below or at the sea levels and the sediments of limestone began to accumulate underneath. Although most of the volcanic eruptions are near the tectonic plates in the earths crust however Arizona has been quite far from the North American Plate. Th e reason of volcanic eruptions in this region is believed to be the molten rock that is the trapped area beneath the Northern Arizona named as the hot spot. This molten rock occasionally rises, moving the plate to the west and creating volcanoes. The Peaks are believed to be formed nearly 500,000 to 1 million years ago however its inner basin has been quite since its formation (Jones). Many geologists name this formation of the San Francisco Peaks as a stratovolcano meaning that it

Special Forces Responses to the New Type of Warfare Essay

Special Forces Responses to the New Type of Warfare - Essay Example Despite the fact that the US is affected by the new type of warfare much like other countries, the OCONUS area also presents a challenge for the Special Force in the sense that the UCP stipulation asserts that there is need for the Force to have an effective presence in this region if the new type of warfare is to be handled properly. For many years, the Special Force has had a presence in the OCONUS area but with a focus to protect the US. This has been reflected clearly in the UCP stipulation that limits the ability of the special forces to carry out activities that are created to prevent emerging threats and form strong relationships with foreign militaries that can help combat the new type warfare. This fact clearly shows that the Special Force needs to change tactics in order to operate effectively (Dinter Jr, 2001).The 9/11 attack brought about a change in consideration of terrorism from just a criminal attack to a new type of warfare on a worldwide level. Another issue of conc ern in the 21st century as a form of new warfare is resource characterized as economic-warfare. Such issues require the Special Force to change its tactics to deal with the new type warfare, which encompasses different issues as shown in this paper. For a long time, the Special Force has used a military strategy to infiltrate into hostile land, sea and or air to conduct a variety of operations, many of them classified to them. Most of the operations carried out by the Special Force are determined to tackle terrorism.

The Contingency Of Identity In Trainspotting Philosophy Essay

The Contingency Of Identity In Trainspotting Philosophy Essay The perimeters of someones body are often thought to signify the enclosure of a stable perception of the world. For example, mainstream Western society perceives corporeal limits as the impenetrable barrier between subjectivity and external forces. This model emphasizes the subject as regulator over what external forces influence their subjectivity, and in turn implies that the subject is autonomous in choosing or being her own identity. Philosophical projects such as the Enlightenment and the American dream expound on the Cartesian Isi assertion that anyone has the agency to construct an original, autonomous identity. These philosophies have helped bind Western ontology to a concept of mind over matter. However, 20th century thinkers have challenged this notion. Philosopher and sociologist Michael Foucault posits the body is transformed into an instrument for political power, and that conceptualizing subjectivity as a stable construct is crucial to the preservation of the state For Foucault, any notion of autonomy is an articulation of political agenda. Correspondingly, Psychoanalyst Julia Kristeva shows that restricting subjectivity to an epidermal container oppresses an entire means of understanding subjectivity. Kristeva asks the reader to consider a perception of subjectivity that contingently and provisionally fluctuates in its relation to the bodys perceived borders. She claims subjectivity and the body are entwined in an ontology based on the transgression of borders, not the establishment of them. Instead of agreeing with the Wests claim that citizens conduct their selfhood within epidermal boundaries, Kristeva argues that subjectivity is unstable, fragmented, and dispersed across various relations with the body. Therefore, subjectivity has the capacity to transform and be transformed through engagement with the body. Toward this end, I will investigate the ever-fluctuating bodies and identities in Irvine Welshs multimedia text Trainspotting (Boyle, 1996; Welsh, 1996). The film and novel epitomize the permeable, fluctuating nature of subjectivity as conceived by Kristeva, and thus highlight the fact that selfhood depends on a transgression rather than an establishment of borders. Foucault and Doeile Bodies Michael Foucaults term body politics refers to the practices and policies through which powers of society regulate the human body, as well as the struggle over the degree of individual and social control of the body. Institutional power expressed in government and laws is the power at play in body politics (Body Politics). Foucault says that Western societys false ontology makes citizens think they have stable identities because of the governments regulation of the physical body through institutions and laws. In short, citizens perceive themselves as autonomous subjects because of the states emphasis on hygiene and cleanliness. Foucault says this ontology is the effect of political power, and that any selfhood a proper citizen assumes is an articulation of this power. Associate Professor Nick Mansfield, head of the cultural studies department at Macquarie University in Sydney, Australia, specializes in Foucaultian theory, and his book on subjectivity lends a nice segue as to how body politics and self-hood coincide: Our philosophies of science, our theories of the organization of society, our sense of morality, purpose and truth all partake of the same emphasis on the individual not only as a social quantity, but as the point where all meaning and value can be judged. This individuality is described as freedom, and we still direct our most serious political ambitions towards perfecting that freedom. It also operates as a duty, however. (60) Foucault focuses on the implicit sense of duty that is entailed with citizenship. He sees civic duty as the submission of ones body to forces of political power. Critically acclaimed Italian political philosopher Giorgio Agamben has stated that one of the most persistent features of Foucaults work is its decisive abandonment of the traditional approach to the problem of power, which is based on juridico-institutional models (the definition of sovereignty, the theory of the State), in favor of an unprejudiced analysis of the concrete ways in which power penetrates subjects very bodies and forms of life (5). Foucaults critical studies of social institutions reveal that institutional surveillance of the body-specifically in delineating what is the clean and proper body-designates citizens corporal existence as a docile state. Foucault supports this claim with his concept of processes of subjectivization, These processes under-thematize and universalize the body until it can be treated as inert or disordered; in other words, until physicality obtains a docile classification. Similarly, as cultural theorist Elizabeth Grosz argues, the body historically has been conceived of as a vehicle for the expression of an otherwise sealed and self-contained, incommunicable psyche. It is through the body that [people] _ .. can receive, code, and translate the inputs of the external world (9). Once I established how a favorable perception of the docility is impressed upon populations, I will discuss how Trainspotting characters refute this platform with their own counter-culture philosophies and behavior. The characters struggle with the implications of properness and duty that Foucault sees as essential to the function of a citizen. They are good examples of the insight that Julia Kristeva gleans from Foucaults work: a society and state that glorifies corporeal purity is thus dependent on sources of misery and degradation in order to have a standard to judge what is clean or unclean, appropriate or unfitting. But first, I will establish how body hygiene becomes such an important factor for citizens to view themselves as autonomous subjects. As mentioned, Foucault points to state institutions that enact processes of subjectivization. Processes of subjectivization refer to government programs that exemplify epidermal perimeters as impenetrable borders that contain the supposed autonomous nature of citizens These processes bring the individual to bind himself to his own identity and consciousness, and, at the same time, to an external power (Agamben 5). Mansield elucidates, in our fantasy of autonomous selfhood, we normally imagine our subjectivity to be identified with the uniqueness and separateness of our individual bodies. We draw an imaginary line around the perimeters of our bodies and define our subjectivity as the unique density of matter contained within that line. When we operate in society as voters, taxpayers, welfare recipients and consumers, our identity seems to be married to this autonomy: we front up for interviews, check ups and interrogations as the content of our bodies. (82) The tangible presence bodies provide people with is taken to be absolute and final validation of who they are. When someone appears for a doctors appointment or a cotut trial she ceases being a name on a paper and appears as herself These processes of subjectivization imply not only the notion that someones tangible borders give them a real identity, but also that that identity maintains its own agency. When analyzing state systems from Foucaults perspective, it becomes apparent that citizenship designates citizens as autonomous. Foucault insists that when institutions seek to control and know the subject, they manipulate the body, fixing it strictly in place, watching and measuring it; this in turn gives citizens the sense that they are anything but a carefully monitored, social denomination. But in reality, the state has a vested interest in its citizens health that is expressed by institutional programs emphasis on autonomy. Through subjectivization processes, an inherent notion of cleanliness is attached in the definition of citizen, and the upkeep of clean borders is expected to entail some sort of autonomy. In contrast, Foucault claims that institutions endorsing corporeal cleanliness ensures a specific type of docility in the citizenry. If citizens believe that they are the agents merely because of their hygiene, then the institutions have succeeded in transforming its citizens bodies into inert entities that can be prescribed or delineating in any way the state sees fit. The sense of autonomy is therefore revealed to preserve state power. Foucaults second example of subjectivization processes, that of policing strategies, explains this more explicitly. Foucault states that the laws of the penal system, which were once isolated in the form of a public event (e.g.: a criminal dismembered in the marketplace), have become instilled into normative ontology with the creation of prisons. Firstly, the prison does not simply incarcerate people arbitrarily. It depends on a system of proper proceedings that in turn must be justified by codes of law or legal precedent. When someone is convicted of a crime, she or he goes from being a person to being a phenomenon. As a type, the individual becomes subject to analysis according to scientific models. Questions begin to be asked, like, what personality traits make this person a criminal? What social conditions lead to his or her crime? Here, the individual is not free and autonomous, but the focal point of larger forces, analyzed by systems of knowledge in what they claim is impartial truth (Lyon 7). Foucault uses the prison model of liberal economist and social reformer Jeremy Bentham (1748-1832) to help explain the casual yet compulsory paranoid lifestyle that is instilled in prisons and reflected in society. According to Foucault, the panopticon is typical of the processes of subjectivization that govern modern life. A panopticon is a circular prison with an empty area in the middle where a guard tower is placed. All of the prisoners cell face inward, and one guard can effectively keep survelliance over all the inmates at once. Furthermore, is an opaque sheet of one-way visible glass is installed in the guard tower, the guard herself would not have to necessarily be present to enact a monitoring system. Likewise, state power organizes the population into individual units that are then subject to monitoring in a system of maximum visibility through implicit accountability. This works most effectively in institutions where schools, hospitals, banks, and departments of social security and tax all keep files on us. People forget about these records, or accept them as a necessary and inevitable part of institutions operations (Lyon 8-9). However, these files are our effective social reality, and contain truths about us that can be manipulated outside of our control. These files and the truth they contain are not our property, and they enhance the state of docility imposed on citizens bodies. Foucault believes that power and the knowledge coincide to ensure the state maintains its docile influence, and in turn preserves its efficiency. Therefore, every institution operates according to its own theories of peoples subjectivity: the unruly adolescent, the remedial reader, the hysterical patient, the credit risk-these are all types of subjectivity that people may or may not occupy, sometimes without even knowing it. Every institution has classes of persons into which everyone who deals with them is distributed. The apparently simple and necessary logic of this categorisation-it is not a conspiracy to oppress us, our common sense says, how could these institutions operate otherwise?- already separates us from one another, isolating us, opening up and closing off opportunities, destining us for certain rewards and punishments. The system of truth on which each institution depends is always already a power at work on us. (Mansfield 62) Thus, individuality is not the highest expression of human life, but the thing social institutions need people to feel they are, so that people remain vulnerable to the truths the state has contrived for its own efficiency. As a result, the self constantly problematizes its place in the world and its relationship to others and to inherited codes of behavior. Therefore, the subject does not simply rely on some unknowable of pure natural subjectivity, but rather produces itself endlessly as a response to its relationship to other and to its cultural and historical context (Mansfield 63). Foucaults ideas encourage an earnestly skeptical attitude towards subjectivity, one that is embodied in Trainspottings main character, Mark Renton. Renton can be seen as anti- subjective because he sees any statement that claims to speak the truth about human subjectivity as an imposition, a technique of power and social administration. Renton voices his reservations: Society invents spurious convoluted logic tae absorb and change people whaes behaviour is outside its mainstream. Suppose that ah knew the pros and cons, know that ahm gaunnae hav a short life, am ay sotmd mind, etcetera, etcetera, but still want tae use smack? They wont let ya dae it. They wont let ye dae it, because its seen as a sign of thair ain failure. The fact is ye jist simply choose tae reject whit they huv tae offer. Choose us. Choose life. Choose mortgage payments; choose washing machines; choose cars; choose sitting on a couch watching mind-numbing and spirit-crushing game shows, stufting fuckin junk food intae yir mooth. Choose rotting away, pishing and shiteing yersel in a home, a total fuckin embarrassment tae the selfish, fucked-up brats yeve produced. Choose life. Well, ah choose no tae choose life. If the cunts cant handle that, its thair fuckin problem (Welsh 187-9). Renton, like Foucault, sees subjectivity as a mode of social organization and administration. For Renton, the state is inherently dependent on its citizens to cultivate a notion of sanctity regarding their lives. Upon this foundation of natural life, the State builds concepts of morality and truth that are articulations of power structures (Agamben 2). Therefore, Renton and his mates seek a subjectivity that does not privilege the sanctity of life. As actor and critic Lewis MacLeod puts it, Welshs characters are not at all interested in the rule of parasite politicians (Welsh 228). Instead they operate on a highly idiosyncratic cultural logic that frequently inverts conventional values (90). The characters experimental subjectivity prioritizes desire and addiction as the most important achievements in life, and the screenplays adaptation of the above quote l elucidates this point. ln the theatrical version, Renton explains: Choose rotting away, pishing and shiteing yersel in a home, a total fuckin embarrassment tae the selfish, fucked up brats that youve spawned to replace yourselves . But why would I want to do a thing like that? I chose not to choose life. I chose somethin else. And the reasons? There are no reasons. Who needs reasons when youve got heroin? Renton has lost faith in any type of subjectivity, and considers a life on heroin just as pointless as a life of gainful employment. From a Foucaultian perspective his reasoning can obtain some credence in that institutions will inevitably wrest all agency away from its citizens. It is interesting to note Welshs novels title describes a pointless exercise enacted within societys establishments. Renton can clearly see the absurdity of society and the meaninglessness of his life, yet his choice is ultimately self-defeating, for as the title of the book suggests, heroin addiction, like trainspotting grown men watching locomotives and noting their identification numbers -is effectively a pointless exercise (Bishop 221-22). Similarly, in Peter Corliss review of the cinematic adaptation of Trainspotting, Welsh and John Hodge explain the importance of the metaphor: Trainspotting, Welsh explains, is the compulsive collection of locomotive engine numbers from the British railway system. But you cant do anything with the numbers once youve collected them. Says Hodge, who culled the brilliant screenplay from Welshs anecdotal novel. Its a nice metaphor for doing something that gives your life a bit of structure but its ultimately pointless. So is the intravenous injection of drugs a palpable pleasure that wastes time, and often, life (85). In his PhD Doctorate entitled The Diminished Subject, Professor Geoffrey Bishop looks at the T rainspotting texts to see how the characters attempt to exercise a new type of subjectivity. Bishop writes, For Renton, heroin use is a determinedly philosophical decision to adopt a counter-discursive practice in order to retreat from a society that makes him an outsider, and threatens his attempts to simplify his existence (ZI9). As I shall show in the following analysis, through the selfish pleasure of drug use Renton attempts to avoid the docility that Foucault talks about In an interview with film critic Andrew OHagan, it is apparent that T rainspotting s director and screenwriter were not attempting to display Kristevas theories in their film. But, as I will discuss, the filmic adaptation of the novel lends itself very well to Kristevian philosophy. Kristeva, Posthumanist Practice, and Trainspotting Julia Kristeva argues that subjectivity depends on someones relation to outside forces. Kristevas ontology is based on a transgression, rather than an establishment, of borders. Likewise, the bodies in Trainsporting illustrate a significant alternative to traditional conceptions of the body as stable and self-contained. I propose that the film calls for a critical approach that attends to bodies as products and producers of posthuman discourses. Posthumanist practice questions the genealogy of moral norms rather than accepting and perpetuating them, and much of Kristevas theory is an enactment of posthuman discourse. In critical theory, the posthuman is a speculative being that represents or seeks to enact a re-writing of what is generally conceived of as human. Posthumanist criticism critically questions Renaissance humanism, which is a branch of humanist philosophy that claims human nature is a universal state from which the human being emerges, and it stresses that human nature is autonomous, rational, capable of free will, and unified in itself as the apex of existence. Thus, the posthuman recognizes imperfectability and disunity within him or herself Instead of a humanist perspective, a posthuman perception understands the world through context and heterogeneous perspectives while maintaining intellectual rigor and a dedication to objective observations of the world. Key to this posthuman practice is the ability to fluidly change perspectives and manifest oneself through different identities. The posthuman, for critical theorists of the subject, has an emergent ontology rather than a stable one; in other words, the posthuman is not a singular, defined individual, but rather one who can become or embody different identities and understand the world from multiple, heterogeneous perspectives (Haraway 3). In what follows, I discuss how body fluids in the film illustrate the instability of corporeal limits as conceived by Julia Kristeva and Judith Butler. Through the lens of these theorists, the characters in Trainspotting can become producers of posthurnan discourses. But tirst, I will briefly discuss the critical reception of the film, inasmuch as responses to it characterize the kind of moralizing judgment that so often I denies another perception like Kristevas. _ In 1996, Danny Boyles film adaptation of Irvine Welshs bestselling novel became the highest grossing British-made film in the United Kingdom in history (Callahan 39). Although other films have addressed the subject of heroin addiction most have done so from a stance of such moral disdain that the characters became little more than exaggerations of an addicted underclass that remains safely Other to mainstream film audiences. In contrast, Trainspotting, even though it portrays the desperation and horrors of drug addiction, the film never grants its audience the privilege of certain moral judgment. It invites audiences to engage with its characters in their own world as they struggle between the desperate need and the always- temporary satisfaction that characterizes life on heroin. The cinematic release of Trainspozling came right after a controversial trend in the fashion industry known as heroin chic, a trend that earned its name by popularizing images of thin, glassy-eyed models who were apparently strung-out in dirty bathrooms or cheap, dingy motels (Craik 19). President Clinton even raised the issue in a widely reported address to magazine editors, charging that the glorification of heroin is not creative Its destructive. Its not beautiful. It is ugly. And this is not about art. Its about life and death. And glorifying death is not good for any society (Clinton). Cultural critic Henry Giroux describes the images associated with heroin chic as nothing more than inspiration for a type of cultural slumming that produces attitudes and actions in which well-to-do yuppies aestheticize the pain and suffering of underprivileged youths (27). Some critics have made similar claims about Trainspotting. One reviewer, for example, said the film belongs to an unoriginal, voyeuristic genre that caters to an addiction to addiction- watching (Kauffmann 38). Other critics dismiss the film and other such films as mere slumfests for the bored upper classes, virtual petting zoos they can visit anytime they want to feel like theyre down with the kids (Callahan 39). Although the films graphic portrayal of self- depravation and misery is at times difficult to watch, other critics claim that the films uncritical, even sympathetic portrayal of junkies overtly glamorizes heroin use. Despite the fact that such arguments allude to possible real world dangers of drug culture and the celebration of its images, they remain anchored in a discourse of negativity. They designate the rhetorical critic to the psychoanalytic position of searching for a lack, whether it is of morals, health, or life. In other words, such arguments can only analyze the  ¬Ã‚ lm based on its failure to do something it presumably should do: adhere to moral norms. A moral argument based on whether Trainspotting does or does not glamorize heroin useand whether or not that is good or badneglects a compelling line of analysis: how the pervasive physicality of the  ¬Ã‚ lm functions rhetorically. The  ¬Ã‚ lmmakers are careful to illustrate both the pain and the pleasure of heroin use, but this evenhandedness seems less the depiction of a moral judgment than an investigation or even a meditation on the transgression of boundaries. Indeed, in an interview, director Damiy Boyle says that the  ¬Ã‚ lm is about being a transgressor Its about doing something that everybody says will kill youyou will kill yourself And the thing that nobody understands is, its not that you dont hear that message, its just that its irrelevant. The  ¬Ã‚ lm isnt about heroin. Its about an attitude, and thats why we wanted the  ¬Ã‚ lm to pulse, to pulse like you do in your twenties (Callahan 39). This pulsing, or this incessant transgressing that Boyle refers to provides a key metaphor for this discussion of corporeality in Trainspotting. A pulse is not characterized by stability or even an interplay between opposite forces. Rather, a pulse is a constant  ¬Ã¢â‚¬Å¡uctuation, what William Burroughs describes as an interdependent relationship between systolic and diastolic movement (Naked Lunch iii). It is in this sense that I conceive of transgression not as an eradication or a crossing of boundaries, but as a recon ¬Ã‚ guration that occurs through continual engagement and response. Bodies connecting and expanding within an economy of bodily  ¬Ã¢â‚¬Å¡uids enact the pulse of the  ¬Ã‚ lm. Bodily Refuse and Identity Julia Kristevas theoretical work on the concept of abj ection has done much to trouble a humanist conception of the discrete, autonomous individual. According to the Oxford Dictionary and Thesaurus, abjection means a state of misery or degradation. Kristeva develops this de ¬Ã‚ nition of the abject by arguing that the signi ¬Ã‚ cance of abj ection lies in its role as an operation through which we continually distinguish ourselves as individuals. She describes abject as a jettisoned object that is opposed to 1 and is radically excluded; the abject draws me toward the place where meaning collapses (Powers 1-2). For example, an image of the emaciated body of a person living with AIDS may evoke sympathy, or in, in some cases, fear, but it also ful ¬Ã‚ lls the role of the abject, infected Other that enables the healthy to feel clean, vital, and even morally superior. Similarly, the starving bodies of third-world countries serve as boundaries or limits that contribute to this countrys sense of nationhood. According to this logic, American identity depends on what America precisely is not (Debrix 1 158). Kristevas notion of a disorganized, abject body challenging the concept of order itself aids to an understanding of Trainspotting in which the characters experiment with a unique ontology based on the transgression of corporeal terms. Rather than quietly remaining outside of the mainstream at designated margins, the abject, as the heroin bodies exhibited in Trainspotting, breaks apart the sanctity and homogeneity of rational public space. Kristeva indicates that bodily boundaries are never  ¬Ã‚ nal and neither are the identities that depend on them. She argues that the self depends on the abject to constitute its border, to be that which lies outside, beyond the set (Powers 2). But she also notes that from its place of banishment, the abject does not cease challenging its master (Powers 2). In this sense, the abject Other never remains at the margins. The abject never remains stagnant, creating stable boundaries for the self. Kristeva thus introduces a dynamism into the concept of identity that depends on a subjects ability to recognize and reject the abject asit gets articulated and rearticulated through the selfs interaction with the Other. In other words, the Cartesian I becomes destabilized to the extent that the humanist emphasis on the mind/body split has been sufficiently troubled with regard to how we construct or acquire a sense of self. Foucault shows how someones perceived autonomy is often merely an extension of state power, and this is important when observing how the characters in Trainspotting both celebrate and struggle for the release of moral or hygienic ideologies that treat them as docile bodies. As Bishop has recently noted, Although Trainspotting was attacked for romanticising drug use, glamorising heroin chic, and over the validity of Welshs description of heroin addiction, such literalist readings not only failed to see past the subject matter, they ignored the possibility of political and philosophical content (219). Kristeva suggests an ontology that is grounded in relations to others rather than in the conscious mind, and when her theories are used in an analysis of Trainspotting they can certainly produce philosophical insight into the concept of subjectivity. Judith Butler links much of her work in Bodies that Matter to Kristevas consideration of the abject. Our self-identi ¬Ã‚ cation, Butler argues, operates within what she calls an exclusionary matrix that relates subjects and necessitates a simultaneous production of a domain of abject beings, those who are not yet subjects, but who form the constitutive outside to the domain of the subject (3 ). She agrees with Kristeva that the abject zone of uninhabitability that de ¬Ã‚ nes the boundaries of the subject will constitute that site of dreaded identi ¬Ã‚ cation against which and by virtue of whichthe domain of the subject will circumscribe its own claim to autonomy and to life (3). However, Butler builds upon Kristevas argument with a point that is essential for this discussion of the abject bodies in Trainspotting. According to Butler, the abjected through abj ection instead of inherently possessing autonomy. Therefore, Renton can be seen as existential explorer of subjectivity, and there are no guarantees in this novel, no happy endings, and no transcendence of the characters into holistic self-present subjects (Bishop 223). g Although Butlers introduction of permeability is helpful, I want to offer another important perspective before continuing. Butler posits a concept of subjectivity based on the repudiation of abj ection. As I have suggested and will explore further throughout this discussion, subjects in the  ¬Ã‚ lm do not and cannot sufficiently negate the abject. Rather, the abject is integral to pulsing-or, what William S. Burroughs might call a constant state of kicking-on which subjectivity depends (Junky xvi). Trainspotting s Alternative Subjectivity The cinematic adaptation of Trainspotting has some key scenes that should elucidate the ontological force of abjection. Depictions of body  ¬Ã¢â‚¬Å¡uids in the  ¬Ã‚ lm illustrate the  ¬Ã¢â‚¬Å¡uctuating, permeable corporeality that Butler describes. The  ¬Ã‚ lm seems to attack any trace of morality or cleanliness inherent in Foucaults analysis, as images abound of body  ¬Ã¢â‚¬Å¡uids contaminating spaces in the most inappropriate of manners. Film critic Andrew OHagan notes that for the young characters shi

Free College Essays - The Last Act of Richard III :: Richard II Richard III Essays

The Last Act of Richard III In Shakespeare's play Richard III, the main character Richard is developed as an actor - to the degree of morbidity. Richard is forever putting on an act, and playing the part that he thinks will most please whomever he shares the stage with at a given moment. Not that to please is his ultimate goal, it is just a means to get what he wants--which is the tempting role of the king. His acts are from the start plentiful, and for some time almost surprisingly effective. To Clarence he plays the Loving and Concerned Brother. His counterfeit fools Clarence into a state of trust that is stunning to the spectator, who knows that the events which make Richard exclaim "We are not safe, Clarence, we are not safe!" (I.i.70) are in fact Richard's own doing. Alone with his audience, Richard plays the part of the Self-confident Villain. The audience serves a function not unlike that of a mirror, only it mirrors character traits rather than looks. He introduces himself as the actor who cannot play the role of lover (i.e. be good) satisfactorily, so he chooses to play the villain (i.e. be bad) instead. The notion that this is a choice, as well as his use of the word play rather than be, underline the fact that to him this is all acting. In front of the audience--his mirror and thus a second self--Richard toys around with the conviction that he can do anything he sets his mind to through the means of his acting abilities. He leaves his audience speechless by going through with the overly ambitious task he sets up. He tells us that he will marry Warwick's youngest daughter, and the next thing you know, he has pulled it off. Whether Anne falls for Richard's sex appeal or his rhetoric is moot, yet she does fall. Richard himself seem s credulous at her giving in so easily; "Was ever woman in this humour woo'd? / Was ever woman in this humour won?" (I.ii.232-233) He talks as if it were a sign that his repulsiveness must in some way appear attractive to her, although the way he expresses this makes me doubt his seriousness. Perhaps this is an attempt at sharing a joke with his audience, his feeling being that as it cannot possibly be his looks she has fallen for, it must be his words.

Case Analysis of Mdd, Gad, and Substance Use

Case Analysis of Comorbid Major Depressive Disorder, Generalized Anxiety Disorder, and Substance Abuse Nicole Gapp University of Minnesota School of Nursing Case Analysis of Comorbid Major Depressive Disorder, Generalized Anxiety Disorder, and Substance Abuse Major Depressive Disorder (MDD) is a mood disorder with symptoms that greatly affect the life of the individual. MDD could in fact be called a public health crisis, as it is projected that it will soon overtake heart diseases as the major worldwide health concern (Boyd, 2008).Diagnostic criteria for MDD are depressed mood or loss of interest or pleasure in nearly all activities, present for at least 2 weeks. Findings and behaviors associated with MDD are disruption of sleep, suicidal ideation, feelings of worthlessness and hopelessness, and fatigue and loss of energy. MDD is also associated with a high impairment in occupational, social, and physical functioning, causing as much disability and distress as chronic medical disorde rs (United States Department of Health and Human Services, 1999).MDD has been shown to be associated with increased medical illnesses. MDD can make everyday living a challenge, as research shows that depressive symptoms are associated with impaired everyday problem-solving ability directly and indirectly mediated through learning and memory, and reasoning (Yen, Rebok, Gallo, Jones, & Tennstedt, 2011). It is important for MDD to be identified and treated early on, as MDD that is not treated appropriately results in recurrent depressive episodes, with each successive episode increasing in severity.As MDD is highly associated with suicidal ideation and suicide, it is imperative that MDD be treated to ensure patient safety. Risk factors for MDD are a prior episode of depression, lack of social support, lack of coping abilities, medical comorbidity, substance use, and presence of life and environmental stressors. In addition, major depression may follow adverse or traumatic life events, especially those that involve the loss of an important human relationship or role in life. Social isolation, deprivation, and financial deprivation are also risk factors (APA, 2002).Genetics play a role in the development of MDD, and deficiency or dysregulation of neurotransmitters are also thought to play a part in its etiology. Psychological theories of MDD hypothesize that an early lack of love and warmth may be involved with the development of depressive symptoms, while developmental and family theorists have proposed that parental loss, emotionally inadequate parenting styles, or maladaptive patterns in family interaction may contribute to the etiology of MDD.Women are twice as likely as men to be diagnosed with MDD, though it is believed that the incidence in men is under-diagnosed. Prevalence rates are unrelated to race (Boyd, 2008). Nursing responses to MDD should involve interventions to treat symptoms within the biologic domain, such as changes in appetite, weight, sleep, or energy, as well as symptoms within the psychological domain, such as changes in mood and affect, thought content, suicidal behavior, and cognition and memory. Many types of interventions are used to treat the varied effects and symptoms of MDD.Pharmacologic interventions, such as selective serotonin reuptake inhibitors, tricylic antidepressants, monoamine oxidase inhibitors, and other classes of antidepressants may be used to decrease or manage depressive symptoms. Medication should be continued for at least six months to a year after complete remission of depressive symptoms. Lifestyle patterns, such as good sleep hygiene, activity and exercise, and adequate intake of well-balanced meals should also be encouraged, as these patterns help the client move toward a healthy daily routine that supports remission or recovery.Psychotherapy, such as cognitive therapy, behavior therapy, and interpersonal therapy, has been shown to be effective in individuals with MDD, and a combination of psychotherapy and pharmacotherapy is recommended for patients with severe or recurrent MDD as a strategy to prevent relapse (Boyd, 2008). In addition, electroconvulsive therapy has been shown to be an effective treatment for MDD, especially severe MDD that has not responded to medications. Major depression frequently occurs in conjunction with ther psychiatric disorders, such as anxiety or substance use disorders, which can also affect antidepressant responsiveness. In such cases, the co-occurring mental health problem should be treated in addition to major depression (President and Fellows of Harvard College, 2011). The patient described in this case analysis has comorbid diagnoses of generalized anxiety disorder and substance abuse. Generalized Anxiety Disorder is a psychiatric disorder characterized by excessive worry and anxiety with an insidious onset.The anxiety of GAD persists for at least six months, with excessive anxiety and worry occurring for more days than not, and for some individuals, persisting daily. Risk factors for GAD are thought to be unresolved conflicts, cognitive misinterpretations, and multiple stressful life events (Boyd, 2008)). Few studies have examined the genetic basis of GAD, but it is thought to be moderately heritable. In clinical settings, the incidence of GAD is equally distributed in women and men. However, in wider studies GAD is twice as common in women.In no studies has the prevalence of GAD been related to race (Boyd, 2008). Patients with GAD often have associated depressive symptoms, and MDD is a common comorbid disorder. For this reason, there has been debate surrounding whether GAD is a separate disorder than MDD, or if GAD symptoms are part of the course of MDD. However, research shows that many patients with GAD do not present with a distinct MDD symptom profile. This does not support the hypothesis that co-morbidity between MDD and GAD is artificially inflated because of the similar symptom criteria required by th e current diagnostic system.Instead, MDE and GAD may be thought of as two distinct diagnostic entities that frequently co-occur because of a shared underlying trait (Sunderland, Mewton, Slade & Baillie, 2010). Current diagnostic criteria state that GAD exists when the excessive worry does not occur exclusively during a mood disorder, psychotic disorder, or pervasive developmental disorder. For example, a patient who experiences persistent excessive anxiety but has minimal or no depressive symptoms would be diagnosed with GAD (Boyd, 2008). However, research has shown that the presence of a comorbid anxiety disorder may make MDD harder to resolve or manage.One particular study comparing individuals with MDD and individuals with MDD and a comorbid anxiety disorder showed that after adjusting for the severity of depression, those in the anxious depression group had significantly younger onset age, had been suffering from depression for a longer period, were more likely to experience a r ecurrence, and obtained lower scores on a scale assessing quality of life. The anxious depression group was also characterized by a significantly higher proportion of individuals reporting significant suicidal ideation and previous suicide attempts (Seo, Jung, Kim, T. , Kim, J. Lee, Kim, J. & Jun, 2011). Patients with GAD are often highly somatic, with many complaints of physical symptoms. One study concluded that painful physical symptoms in patients with GAD are twice as prevalent as in the control group, which consisted of individuals with neither GAD nor MDD. The presence of comorbid MDD was associated with a significantly higher prevalence of painful physical symptoms. Painful physical symptoms were significantly associated with functioning and health status impairment both in GAD alone and in GAD and comorbid MDD compared with controls (Romera, Fernandez, Perez, Montejo, Caballero, F. Caballero, L. , Arbesu & Gilaberte, 2010). In addition, those with GAD also often experience poor sleep habits, irritability, and poor concentration. Patients with GAD often feel frustrated, demoralized, and hopeless. They often feel restless and on edge and experience clinically significant distress or impairment of functioning resulting from anxiety, worry, or physical symptoms. GAD has a significant negative impact on work functioning, although smaller than the effect of MDD (Plaisier, Beekman, de Graaf, Smit, van Dyck & Penninx, 2010).Interventions addressing symptoms of the biologic domain include eliminating caffeine, diet pills, amphetamines, ginseng, and ma huang, which have all been shown to be anxiety-producing substances (Boyd, 2008). In addition, good sleep hygiene should be promoted, as a common symptom of GAD is sleep disturbances. The nurse should teach the patient breathing control and progressive muscle relaxation as calming techniques, help the patient identify other positive coping strategies, and educate the patient on time management.Pharmacological int erventions, such as the use of benzodiazepines, certain antidepressants, and other non-benzodiazepine anxiolytics may be effective in reducing anxiety. Roughly 75% of those with GAD have at least one additional current or lifetime psychiatric diagnosis, with MDD being one of the more common comorbidities. Alcoholism is also a significant problem associated with GAD. Patients may use alcohol, anxiolytics or barbiturates to relieve anxiety, and this may lead to abuse and dependency. Such is the case of the patient described in the case analysis, who also has a substance-related disorder.The DSM-IV-TR defines substance abuse as a maladaptive pattern of substance use leading to clinically significant impairment or distress. This impairment may be manifested by recurrent use, resulting in failure to fulfill major role obligations at work or home, recurrent use in situations that are physically hazardous, recurrent substance related legal problems, or continued use despite feeling persist ent or recurrent effects of the substance. To constitute substance abuse, three or more of these manifestations must be present within a 12-month period.In general, men consume more alcohol and abuse drugs more than women, though women are more likely to abuse prescription medication. Substance abuse and dependency are not correlated so much with gender as with an early age of initiation of substance use (Boyd, 2008). Comorbid mental disorders occur often with substance dependence and abuse. For some, comorbid mental disorders are byproducts of long-term substance abuse. Other people have mental conditions that predispose them to substance abuse, with substance abuse becoming a comorbid problem as they use drugs and/or alcohol to self-medicate existing mental illnesses.There is a well-documented association between depression and alcohol abuse and dependence which cannot be explained solely by the random overlapping of these two conditions. A systematic review of 35 studies estimate d the prevalence of current alcohol problems in depressed patients to be 16%, as compared to 7% in the general population. The three most commonly described causal hypotheses for this comorbidity are as follows: 1) an independent depressive episode (e. g. he self-medication theory), 2) alcohol induced depressive symptoms and 3) the existence of shared biological and environmental factors that predispose persons to both (Cohn, Epstein, McCrady, Jensen, HunterReel, Green & Drapkin, 2011). In addition, men with at least four heavy drinking occasions were found to be 2. 6 times as likely to be classified as being depressed as men who drank heavily less than four times in the previous 28  days (Levola, Holopainen & Aalto, 2011). Specific substances that have been abused by the patient who is the subject of this analysis are alcohol, cocaine, heroin, and the prescription drugs oxycodone and Valium.At the time of admission, the patient was no longer regularly using drugs or alcohol, but his history of substance abuse, including overdose, is extensive. Thus, although the patient is already withdrawn from drugs and alcohol, his long-term substance use has significant physical and mental consequences. The depression of the central nervous system by alcohol causes relaxed inhibitions, heightened emotions, mood swings, and cognitive impairments such as reduced concentration and attention, and impaired judgment and memory. In particular, this patient engages in periodic binge drinking, drinking up to 15 drinks in one evening.This alcohol use would result in several days of intoxication, which were interspersed with periods of sobriety. The amount of alcohol consumed in an episode of binge drinking can cause severely impaired motor function and coordination difficulties, emotional lability, stupor, disorientation, and in extreme cases, even coma, respiratory failure, or death. Long-term abuse of alcohol can adversely affect all body systems, and research has shown a conne ction between alcohol dependence and increased risk for diabetes mellitus, gastrointestinal problems, hypertension, liver disease, and stroke (Smith & Book, 2010).Cocaine users typically report that cocaine enhances their feelings of well-being and reduces their anxiety. However, long-term cocaine use leads to increased anxiety. Severe anxiety, restlessness, and agitation are all symptoms or cocaine withdrawal. Withdrawal causes intense depression, craving, and drug seeking behavior that may last for weeks (Boyd, 2008). Valium, a benzodiazepine, is a prescription drug that this patient abused. Patients who abuse benzodiazepines often feel hyperactive or anxious after using them.Often, patients who abuse these drugs combine them with alcohol, putting the patient at risk of coma or death. Symptoms during benzodiazepine withdrawal include anxiety rebound, such as tension, agitation, tremulousness and insomnia, as well as symptoms of autonomic rebound, sensory excitement, motor excitati on, and cognitive excitation, such as nightmares and hallucinations (Boyd, 2008). Opiates are powerful drugs that can quickly trigger addiction when used improperly. Heroin is an opiate that was abused by this patient.Heroin is the most abused and most rapidly acting of all opiates. It can be injected intravenously, and such was the method of delivery for this patient. Heroin produces profound degrees of tolerance and physical dependence. Withdrawal from opiates should be tapered, and if abruptly withdrawn from someone dependent on them, severe physical symptoms may occur, along with nervousness, restlessness and irritability (Boyd, 2008). In addition to heroin use, the patient attempted to commit suicide by overdosing on oxycodone, a prescription opiate.Overcoming substance abuse and preventing relapse can be especially difficult as denial is common in substance abusing patients. Denial is defined as the patient’s inability to accept his loss of control over substance use, o r to accept the consequences associated with the substance use (Boyd, 2008). Because many patients find it difficult or impossible to believe they have a serious problem with drugs and alcohol, many do not seek treatment, or stop treatment prematurely. Motivation is a key predictor of whether individuals will change their substance abuse behavior.Several effective modalities are used effectively to treat addiction, such as 12-step programs, social skills groups, psychoeducational groups, group therapy, and individual and family therapies. Depending on the individual, different treatment techniques will be more or less helpful. History of Present Illness The patient is a 58-year-old Caucasian male who was participating in a partial hospitalization program (PHP) at Hennepin County Medical Center (HCMC) for the treatment of severe major depressive disorder. He has been involved in PHP since his last discharge from the HCMC psychiatric inpatient unit in early March.The patient was coope rative with treatment and medication compliant. He was put on a 72-hour hold after becoming angry and hostile during the PHP group and threatening to hang himself that evening when he got home from PHP. He eventually committed himself voluntarily to the HCMC psychiatric inpatient unit. Upon introduction, the patient appears to be clean, casually dressed, and of normal weight. He is alert and oriented. His attention, cognition, and abstract reasoning are intact, and his thought content is appropriate and organized.In conversation, he is pleasant and cooperative, exhibiting a stable mood and a slightly blunted affect. The patient will talk to staff members but interacts minimally with peers and does not attend groups unless encouraged by staff. The patient has a normal gait but moves quite slowly. In addition it appears that his thought processes are slowed, as he is slow to respond during conversation and seems to have difficulty finding the words to express what he wants to say. The patient appears to have intact recall, short-term, and long-term memory.He appears to be an adequate historian though he exhibits poor judgment due to his depressive and anxious symptoms, as evidenced by his extensive history of drug and alcohol abuse and dependency. The patient has psychiatric diagnoses of severe and recurrent major depressive disorder, generalized anxiety disorder, and polysubstance abuse. The patient has been suffering from MDD with chronic suicidal ideation since age 15. His first suicide attempt was at age 15, and he began abusing drugs and alcohol at approximately the same time.His extensive history of substance abuse includes use of alcohol, cocaine, and IV heroin. His alcohol abuse as a teenager led to a DWI charge. He has participated in mental health outpatient treatment and has undergone chemical dependency treatment numerous times. He completed high school without apparent difficulty. The patient seems to be of average intelligence, though his IQ is not listed in the record. He does not have a history of violent or sexual crime. He has a history of five suicide attempts. He began smoking as a teenager and currently smokes one pack of cigarettes per day.In 1983, the patient married and remained so until his wife died 25 years later, in 2008. He had no children. According to the patient, he was happily married, and he called his relationship with his wife â€Å"the best thing that has ever and will ever happen to me. † While he was married, he got completely clean from drugs and alcohol, remaining drug free and sober for 12 years. Though he struggled with episodes of depression and suicidal ideation, he was able to manage his symptoms with medication and mental health outpatient treatment. Most of my problems faded into the background,† said the patient. During this time, he and his wife bought a condo, and the patient was employed as a janitor and handyman, working at the Minneapolis-Saint Paul airport. He remained at this job for over a decade and was promoted to the position of supervisor. He had, as he said â€Å"everything I ever wanted. † In 2007, his wife became very ill and eventually died in 2008 after complications from a surgery intended to prolong her life. The patient reports that as his wife got sicker, he became increasingly depressed.Unlike in the previous 12 years, medication and outpatient treatment did not seem to manage his symptoms. In addition, he started experiencing extreme and persistent anxiety, feeling â€Å"like I was always one second away from a panic attack. † He was diagnosed with generalized anxiety disorder and was prescribed benzodiazepines to manage this condition. As his wife got sicker, he slowly began to self medicate with alcohol and admitted to â€Å"popping an extra pill† occasionally to decrease his anxiety.When his wife died, the patient became so depressed and anxious that he was unable to concentrate at work. He had to give up his job as a supervisor, and said, â€Å"I couldn’t even manage myself, how was I supposed to handle anyone else. † As his depression and anxiety got worse, he turned increasingly to alcohol and drugs. He reported binge drinking, consuming up to 20 drinks in one evening. He would remain intoxicated for several days, and would switch to using drugs as the alcohol cleared his system. He reported being either drunk, high, or both almost every day.Although he used cocaine and heroine, which were the drugs he used as a teenager, he also became dependent on prescription benzodiazepines to manage his increasingly severe anxiety. The increase in anxiety may be explained by his cocaine use, which, though it reduces anxiety while high, causes increased anxiety with long term use. Additionally, though proper use of benzodiazepines decreases anxiety, benzodiazepine abuse or dependency results in increased anxiety levels. When his request for more prescription benzodiazepines was denie d due to drug seeking behavior, he gained possession of Valium illegally and continued abusing them.He was arrested for illegal Valium possession in 2009, and received two DWIs between 2008 and 2011. His medical record notes that he has a history of antisocial behavior, though it does not expand on this statement beyond the mention of his previous arrests. With no income coming in and increasing amounts of money used to fuel his drug and alcohol addiction, he lost his condo and all of his savings and was living at the Salvation Army homeless shelter by June 2008. His depression grew in severity as the major life losses piled up and his substance dependency problem worsened.In 2008, he lost consciousness due to heroin intoxication. In August of that year, the patient overdosed on oxycodone, intending to kill himself. He was brought to HCMC, and for the past several years has experienced being in and out of the psychiatric inpatient. In 2010, he moved from the homeless shelter to Alte rnative Homes in Minneapolis. Following his latest psychiatric hospitalization in March, he began the partial hospitalization program at HCMC. Upon discharge from the current hospitalization, he will be returning o Alternative Homes and participating again in the PHP program. A common finding associated with a diagnosis of either MDD, GAD, or substance abuse is the presence of sleep disturbances. Such is the case with the patient described. These sleep disturbances may present themselves as difficulty falling asleep, trouble maintaining sleep, or waking up too early (National Insititute of Health, 2005). This patient currently experiences insomnia, getting only 3-4 hours of sleep per night. Reportedly, this insomnia has been a chronic issue.The insomnia the patient experience sets him up for a negative cycle. Because of his depression and anxiety, it is difficult for the patient to sleep. This lack of sleep, in turn, exacerbates his anxiety and depressive symptoms. As his symptoms p rogress in severity, he turns to substances to self medicate. The use of substances results in a worsening of his insomnia. Thus, finding a way for the patient to get adequate sleep is important. He has tried a variety of medications to promote sleep, but none have been effective.He can no longer be prescribed many of the medications for insomnia because of his history of abuse and overdose using prescription drugs. Thus, the options available to him for sleep promotion lie in the realm of sleep hygiene promotion. The patient might also consider participating in a sleep study, as this may reveal additional factors that prevent him from getting the sleep he needs. In addition to his mental illnesses, the patient also has significant medical problems. He has been diagnosed with hypertension, hepatitis C, diabetes mellitus, osteoarthritis of the left shoulder, and acid reflux.Research shows that diabetes mellitus, gastrointestinal problems, hypertension, liver disease are correlated wi th substance abuse (Moffitt, Caspi, Harrington, Milne, Melchior, Goldberg & Poulton, 2010). Indeed, the patient’s hepatitis C is a direct consequence from his use of street drugs. Interestingly, multiple studies have revealed that not only are depressive symptoms a risk factor for the development of type 2 diabetes, but they have also been shown to contribute to hyperglycemia, diabetic complications, functional disability and mortality among diabetic patients (Moffitt et al. 2010). Also, as previously discussed, patients with GAD and MDD report more painful physical symptoms than the general population, and the patient’s osteoarthritis pain could well be exacerbated by the presence of these psychiatric conditions. Thus, it is possible that with improved management of his psychiatric conditions, his medical problems may improve as well. Family and Social History The patient’s social and family history is somewhat lacking. The patient was adopted at a young age.He has three non-biological brothers and he reports that he is estranged from all of them, and is not willing to contact them until he has â€Å"my life back together. † In addition, both of his adoptive parents are dead. The patient was not keen on discussing his adoptive family or his childhood and adolescence, but stated that this adoptive family â€Å"were good people, and tried hard to give me everything I needed. † He denies any history of physical, emotional, or sexual abuse. According to the social history, there is no history of mental illness in his adoptive family.This does not mean that environmental or social factors play no role in the etiology of his mental illness, but that these factors may be less obvious. Information on the patient’s biological mother and family history is unavailable. The patient was given up for adoption at birth, and remained a ward of the state, living in various foster homes, until he was adopted at age 3. As the patient wa s given up for adoption and adopted at such a young age, he has he has no recollection of his biological family or his time in the foster care system.Any instances of abuse, neglect, or trauma in his early years are thus unknown. Because there is no available family history, it is impossible to know if any of the patient’s first-degree relatives suffered from mental illnesses, or if the biological mother used drugs or alcohol during her pregnancy. This lack of information is unfortunate, as it is impossible to conjecture whether, or to what degree, the patient’s mental disorders have a basis in genetics or in disturbed fetal development.Because MDD, GAD, and substance abuse have all been shown to have a moderate to high degree, of heritability, it is very plausible that mood, anxiety, or substance related disorders were present in his biological family. The patient seems to have very limited social support, as he is estranged from his adoptive siblings and has no commu nication with his biological family. The patient also has a history of limited social interactions and close friendships. He reports that he has felt disconnected from others for as long as he remembers, and that he had few close friendships throughout his childhood, adolescence, and adulthood.In addition, the patient reports that most of the relationships that he would call the closest have been with people who have substance abuse problems, as he spent â€Å"years and years running with the wrong crowd. † The basis of most of these relationships was a shared interest in drug and alcohol use, and he does not think that these friends would be of any support to him in pursuing and maintaining recovery. During the time that he was sober, he states that his wife was â€Å"the only friend I really needed† and as a result, he did not form many close friendships with his peers.He states that he currently has no supportive relationships. Furthermore, he has little desire to f orm such relationships. Application of Developmental Theories Viewing the patient and his family and social history through the lens of attachment theory provides a possible framework for viewing the patient’s development of mental illnesses. Attachment theory, a biologically based framework first proposed by John Bowlby in the mid 1950s, is the theoretical approach used to describe the importance of stable and secure relationships of all infants, especially those in foster care (Bruskas, 2010).This theoretical approach reasons that infants and children have a need to belong and to experience secure relationships with a small number of consistent â€Å"preferred† primary caregivers in order to successfully develop into normal healthy adults who can actively and emotionally participate in social life (Boyd, 2008). In particular, a child should receive the continuous care of this single most important attachment figure for approximately the first two years of life.If the attachment figure is broken or disrupted during the critical two year period the child will suffer irreversible long-term consequences of this deprivation, which might include delinquency, reduced intelligence, increased aggression, depression, and affectionless psychopathy–an inabilityto show affection or concern for others. Research, such as the Adverse Childhood Experiences Study, correlates untreated childhood adversity with an increased risk toward poor developmental health and other major diseases seen later in life such as cardiac disease, depression, and even premature death (Felitti & Anda, 2010).Studies reveal that infants in foster care are among the most vulnerable because of their complex and immense brain development, and the importance of attaining developmental milestones. The onset of brain development begins soon after conception and will continue to mature well into adulthood, but the most abundant and dramatic time of growth is during the first few years of life, specifically within the first three years. The primary and most important developmental milestone for any infant is to establish a relationship, especially one with a primary caregiver.This period presents sensitive â€Å"windows of opportunity† for the development of particular parts of brain structure and circuitry influenced and dependent on social experiences for optimal brain development (Bruskas, 2010). The majority of children entering foster care are infants, and the impact of not addressing mental health needs of preverbal children can have deleterious effects (National Research Council Committee on Integrating the Science of Early Childhood Development, 2000).Although an infant may not be able to articulate losses because of their preverbal age, they nonetheless experience grief and loss, and for many, these experiences will be forever embedded in their memory (Felitti & Anda, 2010). Moreover, the consequences of unresolved losses have a much more devastati ng affect in infancy than adulthood because of the potentially permanent psychological impact on the developing brain of an infant or child (Bruskas, 2010).Infants and children in foster care who are not afforded supportive primary caregivers to help them develop an internal ability to regulate their own will continue to use whatever coping methods they can. Under stress-provoking adversities such as abuse, neglect, and relationship disruptions, children’s coping strategies to manage such circumstances may present as hostility, frustration, and anxiety with underlying feelings of fear, abandonment, and powerlessness (Bruskas, 2010).The relationships infants and children develop while in foster care are crucial; relationships characterized by trust and commitment help an infant or child become more resilient toward the challenges and obstacles that all humans face in life; conversely, a lack of such relationships in life can result in long-term dysfunction socially and physica lly. Attachments and â€Å"templates† of the world are significantly developed by the time a child reaches a year old (Bruskas, 2010).Efforts to address behavioral problems later in life may prove to be more difficult and costly as brain structure becomes permanent and behavior becomes more difficult to change. Due to the patient’s experience of foster care as an infant and toddler, it is likely that he was unable to form a secure attachment with a primary caregiver. Although this disruption in attachment is not the sole contributor to his problems with depression, anxiety, and substance abuse, it is very possible that the chaotic structure of his early years play a large role in the development of these conditions.Applying the concepts of Erikson’s model of psychosocial development allow for a greater understanding of the patient’s current state. Because of the disruption of relationships early in life, the patient may not ever have resolved the developm ental conflict of basic trust vs. mistrust, which is often resolved in infancy. This may be one reason behind his feeling of disconnectedness from others. According to Erikson, this inability to resolve this developmental conflict results in a decreased sense of drive and hope. It is also likely that the patient was able to resolve the developmental conflict of autonomy vs. hame and doubt, which is often resolved in toddlerhood (Boyd, 2008). This may explain the patient’s reliance on his wife as the sole supportive relationship in his life, as well as his fast descent into previous behaviors after his wife’s death. As the patient was never able to develop a sense of autonomy, it seems that he became extremely emotionally dependent on his wife. Because of this relationship, he was able to progress at his job and maintain his recovery. However, with the death of his wife, he was brought back to the conflict of autonomy vs. shame and doubt.Really, it was through the prese nce of his wife that he was able to take initiative, be industrious, and have an intimate relationship, all of which are successful outcomes of developmental conflicts. The marriage provided him with hope, purpose, a sense of devotion and fidelity, as well as affiliation and love. In short, it seems that his wife was his mental and emotional anchor. The recurrence of symptoms of his mental disorders after the loss of the anchor of his life threw him back into the early developmental conflicts that he was unable to resolve due to his unstable childhood.According to Erikson, in order for the patient to move forward from his regressed state he must tackle and resolve the conflicts of trust vs. mistrust, autonomy vs. shame and doubt, initiative vs. guilt, industry vs. inferiority, identity vs. role diffusion, and intimacy vs. , isolation to reach the adulthood stage of generativity vs. stagnation. Ultimately, with the resolution of all these conflict, the patient will reach a mature sta te in which he is able to attain ego integrity instead of falling into despair. Patient Prognosis and Treatment RecommendationsIt is important to remember that the patient was seeking help and trying to recover prior to his most recent hospitalization. He was enrolled in and regularly attending the partial hospitalization program. In addition, he was no longer abusing drugs or alcohol. PHP staff report that he had been medication compliant, cooperative, and was motivated to change. The patient’s recent hospitalization was precipitated by a change in drug dose and type. He reported that it was only after the medication change that the suicidal ideation intensified.Thus, an important goal for this patient is to find the drug types and dosages that will successfully manage his depression and anxiety. However, because the patient has such an extensive history of addiction, primary care providers are hesitant to prescribe large dosages of often highly addictive medications. This h esitation is especially understandable given the patients past abuse of prescription drugs, including an overdose with the intent to commit suicide. However, the types and dosages of the drugs he is currently receiving are not enough to manage his symptoms.The severity of the patient’s depression and anxiety necessitates the use of powerful antidepressants and anxiolytics, but his past substance abuse and dependency make the prescription of these drugs a last resort. Appropriate pharmacotherapy is also complicated by the fact that this patient has tried various classes and types of drugs to manage his symptoms, but no drug therapy has been effective enough to prevent the periodic recurrences of major episodes of depression and anxiety.To manage his depression, the patient has tried typical and atypical antipsychotics, anticonvulsants, tricyclic antidepressants, monoamine oxidase inhibitors, and selective serotonin reuptake inhibitors, as well as other classes of antidepressan ts, such as Serotonin Norepinephrine Reuptake inhibitors, Norepinephrine Dopamine Reuptake Inhibitors, Alpha-2 Antagonists, and Serotonin-2 Antagonist/Reuptake Inhibitors. Although the apparent failure of all these drugs to manage his depression might cause one to suspect that he is exhibiting purely drug seeking behaviors, the depressive symptoms he xperiences impair and affect him so severely that a denial of the reality of these symptoms would be unsafe and unethical. Electroconvulsive therapy has been recommended to treat his depression, but the patient has refused to undergo this treatment modality. The patient’s anxiety is more easily managed than his depression, and benzodiazepines have proven effective. However, his past abuse of benzodiazepines make his primary care providers reluctant to give them to him, and they have prescribed non-benzodiazepines, such as Buspar and Zolpidem, instead.Unfortunately, these medications have not been effective in controlling the pati ent’s anxiety. As a result, the patient has been asking repeatedly for benzodiazepines, while promising that he will use them responsibly. Ultimately, for the patient to achieve effective maintenance of his comorbid mental disorders, he must be able to take medications as prescribed. Due to his history of substance abuse and his still unstable depression and anxiety, it is unlikely that the patient will be able to take his medications as prescribed.It is recommended that a staff member have control of his drugs while he is attending the PHP, and that once discharged, a home health nurse be sent to administer his medication. This would reduce the potential for abuse. In addition, the use of coping mechanisms besides substance abuse may help the patient adhere to the prescribed drug regimen, as well as decrease his depression and anxiety. Coping skills the patient has identified as helpful are watching television and spending some quiet time alone.However, interaction with othe rs should also be encouraged, as too much time spent alone will only reinforce depressive symptoms of isolation. An increase in the quantity and quality of sleep will also aid the patient in his recovery, as sleep deprivation is positively correlated with depressive symptoms and anxiety levels. The patient’s prognosis is one of cautious hopefulness. Though the patient has experienced severe recurrences of MDD, GAD, and substance abuse in recent years, the patient had maintained a long period of sobriety prior to this, during which he was happy, productive, and high functioning.The patient’s ability to achieve remission from his mental illnesses during his marriage to his wife shows that investing in a supportive relationship is an important and powerful coping skill for this patient. Thus, if the patient is able to form and maintain new supportive relationships, his chance of recovery will improve substantially. It is also important to remember that he was doing very w ell until his wife died. According to the Holmes and Rahe Index, the death of a spouse is the number one most stressful event that occurs in the life of an individual (Perry & Potter, 2009).It is not an exaggeration to say that with his wife’s death, life as he knew it ended. Many people experience periods of long and severe depression following the death of a loved one. For this patient, his descent into depression, combined with the resurgence of his anxiety sent his life into a complete tailspin. Under the severe stress of not only his wife’s death but also his inability to keep working, he returned to his former coping mechanisms of drug and alcohol abuse.These habits detracted him from working through the grief of his wife’s death, and furthermore caused him to lose his house and his savings, thus increasing his depression and anxiety, thus perpetuating the substance abuse. Now that the patient has withdrawn from drugs and alcohol and is in a safe environme nt, he can continue his grief work. As a result, his depression may begin to subside, and he may be able to get closer to his previous level of functioning. DSM-IV-TR Axis I: Major Depressive Disorder, Generalized Anxiety Disorder, Polysubstance Abuse Axis II: Cluster B traitsAxis III: Hypertension, Hepatitis C, Diabetes Mellitus, Type 2, Osteoarthritis of the left shoulder, Acid Reflux, Bilateral hearing loss Axis IV: Chronic mental illnesses, chronic medical conditions, death of spouse, family estrangement, lack of social support, unemployment, financial insecurity, acute hospitalization, Axis V: 35 (current), 75 (potential) Patient Goals: †¢ I want to find medications that will help my depression and anxiety †¢ I want to keep from abusing my medications †¢ I want my grief over my wife’s death to get better †¢ I want to take one day at a time †¢ I want to feel less alone †¢ I want to get better sleepNursing Goal: Patient will be safe during hos pital stay. Interventions: †¢ Assess for suicidal ideation every shift. †¢ Perform rounds every 15 minutes to ensure patient safety. †¢ Ensure that the patient has no access to potentially harmful objects and/or substances. †¢ Observe, record, and report any changes in mood or behavior that may signify increasing suicide risk and document results of regular surveillance checks. Nursing Goal: Patient will seek help in dealing with grief-associated problems. Interventions: †¢ Develop a trusting relationship with the client by using empathetic therapeutic communication (Eakes, Burke & Hainsworth, 1998). Educate the client that grief resolution is not a sequential process and that the positive outcome of grief resolution is the integration of the deceased into the ongoing life of the griever (Matthews & Marwit, 2004). †¢ Identify available community resources, including grief counselors and community or Web-based bereavement groups. †¢ Focus on enhanci ng coping skills to alleviate life problems and distressing symptoms such as anxiety and depression. Nursing Goal: Patient will practice social and communication skills needed to interact with others. Interventions: †¢ Discuss causes of perceived or actual isolation. Assess the patient’s ability and/or inability to meet physical, psychosocial, spiritual, and financial needs and how unmet needs further challenge the ability to be socially integrated. †¢ Use active listening skills to establish trust one on one and then gradually introduce the patient to others. †¢ Provide positive reinforcement when the patient seeks out others. †¢ Encourage the client to be involved in meaningful social relationships and support personal attributes (Gulick, 2001). Nursing Goal: Patient will use effective coping strategies instead of abusing drugs and alcohol.Interventions: †¢ Assist the client to set realistic goals and identify personal skills and knowledge. †¢ Use verbal and nonverbal therapeutic communication approaches including empathy, active listening, and confrontation to encourage the client to express emotions such as sadness, guilt, and anger, verbalize fears and concerns, and set goals. †¢ Offer instruction regarding alternative coping strategies (Christie & Moore, 2005). †¢ Encourage use of spiritual resources as desired. Nursing Goal: Patient will identify actions that can be taken to improve quality of sleep.Interventions: †¢ Obtain a sleep-wake history, including history of sleep problems, changes in sleep with present illness, and use of medications and stimulants. †¢ Encourage the patient to develop a bedtime ritual that includes quiet activities such as reading, television, or crafts. †¢ Encourage the patient to use soothing music to facilitate sleep (Lai & Good, 2005). †¢ Teach the patient sleep hygiene guidelines for improving sleep habits (ie. go to bed only when sleepy, avoid afternoon an d evening naps, use the bed only for sleeping, get up at the same time every morning). Use relaxation techniques to decrease anxiety before going to sleep. †¢ Refer to a sleep center if interventions are ineffective. Analysis of Interaction Before interacting with the patient, I read the patient’s medical record and notes. I paid particular attention to ways the patient said he learned best, which for my patient was one on one conversation. Prior to approaching the client, I asked myself if I had any beliefs, biases, or limitations that would affect my interaction with the patient or prevent the formation of a therapeutic relationship.In order to set the tone of a professional therapeutic relationship, I introduced myself to the client, saying that I was a student nurse and shaking his hand. I made some small talk with him about such topics as sports and the patient’s hobbies in order to show interest in the patient and develop rapport. During this conversation, t he patient grew more visibly at ease. His face became less taut, his answers became longer and less forced, and he moved from an erect posture so a somewhat more relaxed position in his chair. The patient spoke slowly and eemed to have difficult finding the words he wanted to use. Such a speech pattern is characteristic of depression, one of the patient’s psychiatric diagnoses. This first conversation was punctuated with the start of morning group. After morning group, I gave the patient some space, as I did not want him to feel overwhelmed or threatened by my questions. About a half hour later, I asked the patient if we could continue the conversation we were having that morning, and he agreed without hesitation. In this second interaction, I began with a few open-ended questions about how group had been.I then started asking the patient some more questions about his readmission into the hospital and precipitating events. I asked open-ended question, and often responded to h is answers by asking further open-ended questions. For example, after asking the patient if he was having suicidal thoughts, he responded that he did not want to hurt himself right now. I replied with the open-ended question, â€Å"So are you feeling safe? † using reflection to redirect the idea back to the patient and allow him to explore whether or not he felt safe.I focused on actively listening to the patient, following the patient’s lead and sometimes asking clarifying questions. Because of the patient’s slower rate of response, I employed the use of silence to allow him to gather his thoughts and proceed at his own pace. As the patient told me more about recent events in his life, including the death of his wife, the loss of his job and his descent into substance abuse, he began to look away more and more. This decrease in eye contact might be the result of the patient feeling ashamed, embarrassed, or guilty about his feelings and behaviors.In order to mai ntain connection with the patient and assure him of my nonjudgmental view of his situation, I used empathy and restatement, saying, â€Å"It sounds as though you have had a very difficult past couple of years. † Upon saying this, the patient looked up, maintained eye contact, and agreed. He then began to expand on his current feeling of hopelessness, saying, â€Å"I wonder if life is worth living, and sometimes I just want to go to sleep and not wake up. † As he explored and expanded on his feelings I alternated between using silence and validating what he said.The silence allowed him to express intense feelings without interruption, while statements of restatement and interpretation, such as â€Å" It sounds like you have been feeling pretty hopeless,† demonstrated empathy and a nonjudgmental attitude toward what the client was feeling. At one point, the patient put his head in his hands, saying â€Å"I had so much going for me, and after my wife died, everyth ing went to pot. † I felt that in this moment, what the client needed was neither a cheery reassurance that things would get better, nor dispensation of advice, but rather a person to understand and acknowledge his current misery.I replied that sometimes life gets you down, and sometimes when it rains it pours, and it’s ok to be sad about that. The patient seemed appreciative of the acknowledgment of his pain and the justification of his sadness. I sat silently with him for 2-3 minutes, as I felt it was important for him to feel, sit with, and process these emotions for a short period of time. During these periods of silence, I continued to lean forward slightly, as I had done throughout the interaction, to show that I was still interested and engaged despite the lack of verbalization.Because I had acknowledged the patient’s hardships and thereby connected with him, I felt that I was in a good position to explore with him goals he had for the future, and ideas th at could help him reach these goals. I made sure to approach this topic not by giving advice or suggestions, but by asking him open-ended questions about what things made him feel less sad or anxious and what things he wanted to work on during his stay. These open ended questions elicited the response of his goals for the future, and his verbalization that he needed to find better coping mechanisms, because his old ones didn’t seem to work.He also stated that he knew he needed to â€Å"continue grieving my wife, because the drugs and alcohol kept me from doing that. † I thought that this realization of substance abuse as inhibitory to his grief process was very insightful, and told him so. He made a small smiling expression and responded that he wanted to â€Å"get back on the straight and narrow† and take his medications â€Å"the way I’m supposed to—no more, no less. † The patient’s elucidation of his goals and his insight into help ful and hindering coping devices was a very positive outcome of this therapeutic conversation.The patient seemed less burdened after the opportunity to talk about his recent losses in life, and more hopeful after verbalizing his goals and ways to meet them. References Ackley, B. J. & Ladwig, G. B. (2008). Nursing Diagnosis Handbook (7th ed. ). St. Louis, Missouri: MOSBY Elsevier. American Psychological Association. (2002). Boyd, M. A. (2008). Psychiatric nursing: contemporary practice (4th ed. ). New York: Lippincott Williams & Wilkins. Bruskas, D. (2010). Developmental health of infants and children subsequent to foster care.Journal of Child and Adolescent Psychiatric Nursing, 23(4), 231-241. doi:http://dx. doi. org/10. 1111/j. 1744-6171. 2010. 00249. x Christie, W. & Moore, C. (2005). The impact of humor on patients with cancer. Clinical Journal of Oncology Nursing, 9(2), 211-218. Cohn, A. M. , Epstein, E. E. , McCrady, B. S. , Jensen, N. , HunterReel, D. , Green, K. E. , & Drapki n, M. L. (2011). Pretreatment clinical and risk correlates of substance use disorder patients with primary depression. Journal of Studies on Alcohol and Drugs, 72(1), 151-157. Eakes, G. G. , Burke, M. L. & Hainsworth, M. A. 1998). Middle-range theory of chronic sorrow. Image Journal Nursing Scholar, 30, 179. Felitti, V. J. & Anda, R. F. (2010). The Relationship of Adverse Childhood Experiences to Adult Medical Disease, Psychiatric Disorders, and Sexual Behavior: Implications for Healthcare. Cambridge University Press. Gulick, E. (2001). Emotional distress and activities of daily living functioning in persons with multiple sclerosis. Nursing Resolutions, 50(3), 147-154. Lai, H. L. & Good, M. (2005). Music improves sleep quality in older adults. Journal of Advanced Nursing, 49(3), 234-244.Lawrence, A. E. , Liverant, G. I. , Rosellini, A. J. , & Brown, T. A. (2009). Generalized anxiety disorder within the course of major depressive disorder: Examining the utility of theDSM-IV hierarchy rule. Depression and Anxiety, 26(10), 909-916. Levola, J. , Holopainen, A. , & Aalto, M. (2011). Depression and heavy drinking occasions: A cross-sectional general population study. Addictive Behaviors, 36(4), 375-380. doi:http://dx. doi. org/10. 1016/j. addbeh. 2010. 12. 015 Matthews, L. & Marwit, S. (2004). Complicated grief and the trend toward cognitive-behavioral therapy.Death Studies, 28, 849-863. Moffitt, T. E. , Caspi, A. , Harrington, H. , Milne, B. , Melchior, M. , Goldberg, D. , & Poulton, R. (2010). Generalized anxiety disorder and depression: Childhood risk factors in a birth cohort followed to age 32 years. Diagnostic issues in depression and generalized anxiety disorder: Refining the research agenda for DSM-V (pp. 217-239). Washington, DC, US: American Psychiatric Association; US. National Institute of Health. (2005). National Research Council Committee on Integrating the Science of Early Childhood Development. (2000). Perry, A. G. , Potter, P.A. (2009). Fundamentals of Nursing (7th ed. ). St. Louis, Missouri: MOSBY Elsevier. Plaisier, I. , Beekman, A. T. F. , de Graaf, R. , Smit, J. H. , van Dyck, R. , & Penninx, B. W. J. H. (2010). Work functioning in persons with depressive and anxiety disorders: The role of specific psychopathological characteristics. Journal of Affective Disorders, 125(1-3), 198-206. doi:http://dx. doi. org/10. 1016/j. jad. 2010. 01. 072 President and Fellows of Harvard College. (2011). Harvard Mental Health Letter. Harvard Health Publications. Retrieved from http://www. health. harvard. du Romera, I. , FernandezPerez, S. , Montejo, A. L. , Caballero, F. , Caballero, L. , Arbesu, J. A. , . . . Gilaberte, I. (2010). Generalized anxiety disorder, with or without co-morbid major depressive disorder, in primary care: Prevalence of painful somatic symptoms, functioning and health status. Journal of Affective Disorders, 127(1-3), 160-168. doi:http://dx. doi. org/10. 1016/j. jad. 2010. 05. 009 Seo, H. , Jung, Y. , Kim, T. , Kim, J. , Lee, M. , Kim, J. , . . . Jun, T. (2011). Distinctive clinical characteristics and suicidal tendencies of patients with anxious depression.Journal of Nervous and Mental Disease, 199(1), 42-48. doi:http://dx. doi. org/10. 1097/NMD. 0b013e3182043b60 Smith, J. P. , & Book, S. W. (2010). Comorbidity of generalized anxiety disorder and alcohol use disorders among individuals seeking outpatient substance abuse treatment. Addictive Behaviors, 35(1), 42-45. doi:http://dx. doi. org/10. 1016/j. addbeh. 2009. 07. 002 Sunderland, M. , Mewton, L. , Slade, T. , & Baillie, A. J. (2010). Investigating differential symptom profiles in major depressive episode with and without generalized anxiety disorder: True co-morbidity or symptom similarity?Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 40(7), 1113-1123. doi:http://dx. doi. org/10. 1017/S0033291709991590 United States Department of Health and Human Services. (1999). Yen, Y. , Rebok, G. W. , Gallo, J. J. , Jones, R. N. , & Tennstedt, S. L. (2011). 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Decontamination and Waste Management Essay

1.1.  Identify different reasons people communicate. A:   People communicate for a variety of reasons. There are several different reasons why people communicate. People communicate each other to: express needs, share ideas, information, to express feelings, to give information and instructions. Read more:  Identify different reasons why people communicate  essay 1.2.  Explain how effective communication affects all aspects of your own work. A:  Effective communication is vital for the social care worker. The service user and the social worker need to understand each other clearly in order for the service user to receive the best possible care. Successful communication involves the social care worker speaking clearly and using phrases and sentences that service users can understand. This also involves the social care worker communicating clearly and openly with other members of staff, the manager and other professionals so as to make sure that the best possible care is provided and that this is done so reliably. 1.3.  Explain why it is important to observe an individual’s reactions when communicating with them. A:  The social care worker should always observe an individual’s reactions to see whether he or she fully understands what you have said to them. If the service user for example looks confused then the social care worker must then adapt their communication and re-phrase the question or statement. In this way communication will be effective. It is also important to observe an individual’s reactions so as to spot anything that may be worrying them or upsetting them; the social care worker will then have to change their approach – this may be noticed through the service user’s change in facial expression or body language. 2.1.  Find out an individual’s communication and language needs, wishes and preferences. A:  Lady A (Dementia): She likes when somebody use simply words, short sentences and not to loud. Lady B (hearing problems): She likes when staff talk to her louder. Lady C (Autism): She likes when we use the same answers for the same questions. 3.1.  Identify barriers to effective communication. A:  Barriers to communication can occur because of speech difficulties due to disabilities or illness for example learning disabilities, dementia, deafness poor eyesight or a stroke. A noisy environment and differences in languages spoken and cultures can also be barriers. 3.4   Identify sources of information and support or services to enable more effective communication. A:  Sources of information and support are immediately available for the social care worker from the supervisor or manager of my care home. There are also specialist services like speech language therapists, translators and interpreters. Further sources could be the internet and the library. 4.1 Explain the term confidentiality. A:  Confidentiality means any information that is held about a particular person is privileged and private. It is the duty of all social care workers to make certain that this information is accessible only to those authorized to have access to it. 4.3 Describe situations where information normally considered to be confidential might need to be passed on. A:  Information about an individual should normally only be shared on a need-to-know basis. All information held within my care home is confidential to the care home as a whole. Other situations where confidential information might need to be passed on is when the individual or someone else is at risk of danger, harm or abuse. 4.4   Explain how and when to seek advice about confidentiality. A:  I would always seek advice from my supervisor or my manager at the earliest opportunity if and when I saw that the information about a service user was being put at risk by the careless behaviour of for example a colleague at work. Depending on the urgency I would either ask them in private in the office or raise this in my supervision.